A few months ago, I went through all published evidence for midlines. This data is included in evidence tables in my online CE course on Midline Catheters. There are no published studies on dual lumen midlines at all. So there are no evidence based outcomes that could be generalized to other facilities or populations.
The facility that I work at is considering a dual lumen midline and the only question we had before we move forward is if there is any information on if you can infuse incompatible medications through the dual lumen considering it is not located in a central vessel. Would this be ok to do? If not we don't feel like a dual lumen would benefit us. Thank you in advance.
There is no evidence to provide the answer to your question.. Given the vast difference in volume of blood flow at the midline tip location and the SVC, IMHO I would say no to infusion of incompatibile medications through a dual lumen midline. A midline was never intended to totally replace a CVAD.
we tried double lumen. In theory, a D/L midline is a great solution. Then you get that argument about incompatible solutions . It's 2 seperate lines. The tip exits in the axilla. Why do nurses believe that two incombatible solutions exiting at the same time, immediately entering into a fast moving blood stream, somehow mix IN that blood and explode?. If that was the case, shouldnt we also look at two seperate peripherals in the same arm and the distance between them, to be sure the the meds don't mix at some point and cause a reaction?...and if so, what is that distance. Please will the nurse that came up with THAT theory enter this conversation and explain how that happens?
We used the Arrow double lumen MST-placed Midlines for several years and now only use the single lumen. Based on data we collected, thrombosis occured more frequently with the use of the double lumens, from the medial exit port specifically. We discharge patients with these midlines for IV therapy < 4 weeks. Inpatients will get Extended-dwell PIVs in the forearm to preserve the upper arm veins for possible PICC placements.
Possible Reasons:
Larger 5.5F french size compared to the 4.5F single lumen
Location of the medial exit port - IV infusion could be causing irritation to the vessel wall compared to a distal lumen IV infusion
Tips from experience:
Single lumen MST-placed Midline which gave us an average of 14 days blood sampling and higher IV therapy completion rate compared to the double lumen. Longest dwell time was 65 days.
Measure tip placement 1-2cm below the axillary line
Do not trim catheter tip
Use anti-reflux connector to maintain catheter patency
A few months ago, I went through all published evidence for midlines. This data is included in evidence tables in my online CE course on Midline Catheters. There are no published studies on dual lumen midlines at all. So there are no evidence based outcomes that could be generalized to other facilities or populations.
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Hello Lynn,
The facility that I work at is considering a dual lumen midline and the only question we had before we move forward is if there is any information on if you can infuse incompatible medications through the dual lumen considering it is not located in a central vessel. Would this be ok to do? If not we don't feel like a dual lumen would benefit us. Thank you in advance.
Thank You,
Chelsea
Chelsea Gavere, RN
There is no evidence to provide the answer to your question.. Given the vast difference in volume of blood flow at the midline tip location and the SVC, IMHO I would say no to infusion of incompatibile medications through a dual lumen midline. A midline was never intended to totally replace a CVAD.
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Ken,
we tried double lumen. In theory, a D/L midline is a great solution. Then you get that argument about incompatible solutions . It's 2 seperate lines. The tip exits in the axilla. Why do nurses believe that two incombatible solutions exiting at the same time, immediately entering into a fast moving blood stream, somehow mix IN that blood and explode?. If that was the case, shouldnt we also look at two seperate peripherals in the same arm and the distance between them, to be sure the the meds don't mix at some point and cause a reaction?...and if so, what is that distance. Please will the nurse that came up with THAT theory enter this conversation and explain how that happens?
We used the Arrow double lumen MST-placed Midlines for several years and now only use the single lumen. Based on data we collected, thrombosis occured more frequently with the use of the double lumens, from the medial exit port specifically. We discharge patients with these midlines for IV therapy < 4 weeks. Inpatients will get Extended-dwell PIVs in the forearm to preserve the upper arm veins for possible PICC placements.
Possible Reasons:
Tips from experience: